| NPI | 1205373859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-20-135565) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9274031) |
| Enumeration Date | 2017-01-20 |
| Last Update Date | 2023-05-29 |